The secret history of acupuncture

The fact that acupuncture has been used successfully in China for 2000 years with very few side effects is something that most surgeons, doctors and pharmacologists could only wish for. John Wood, medical acupuncturist from London.

Theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge. The National Council Against Health Fraud 1990 description of acupuncture.

Psychologists can list plenty of other things that could explain the apparent response to acupuncture. Diverting attention from original symptoms to the sensation of needling, expectation, suggestion, mutual consensus and compliance demand, causality error, classic conditioning, reciprocal conditioning, operant conditioning, operator conditioning, reinforcement, group consensus, economic and emotional investment, social and political disaffection, social rewards for believing, variable course of disease, regression to the mean – there are many ways human psychology can fool us into thinking ineffective treatments are effective. Then there’s the fact that all placebos are not equal – an elaborate system involving lying down, relaxing, and spending time with a caring authority can be expected to produce a much greater placebo effect than simply taking a sugar pill.Harriet Hall, Puncturing the Acupuncture Myth

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Acupuncture is perhaps the most misunderstood of all the so-called complementary/alternative medicine (CAM) treatments – almost everything you’ve ever heard about acupuncture is wrong. It is a history which is rather convoluted. But, before we go into it we need to get a working definition. Webster’s dictionary defines acupuncture thus:

A procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produce regional anaesthesia. For its supporters acupuncture represents ancient Chinese wisdom. It has evolved over thousands of years of experimentation; if it didn’t work, it wouldn’t exist today. It is certainly true that acupuncture goes back a very long way. However, acupuncture should not be seen as exclusively Chinese. it needs to be put into a wider historical and geographical context.

Ötzi the Iceman, Europe’s oldest natural human mummy, lived about 5,300 years ago. He was found in September 1991 in the Ötztal Alps on the border between Austria and Italy. His mummified body is exceptionally well-preserved: Ötzi had tattoos running along his back, right knee and left ankle. They were not decorative and he even had some in areas that had been covered in hair. The mummy and other mummies found with similar non-decorative tattoos has led a number of researchers to conclude that this shows a treatment akin to acupuncture. Ötzi apparently suffered from arthrosis of the lumbar spine. What is interesting about the marks on his body is that they coincide with points usually used by acupuncturists to treat this condition! This may be a coincidence but I think acupuncture has to be seen as belonging to a pre-scientific paradigm of medicine.

In the quote by John Wood that I used in the introduction there is a fallacy known as the argument from antiquity, or appeal to tradition. Because we have been doing something for thousands of years does not make it right. Galen’s theory of the four humours was popular for two millennia. Doctors thought that bloodletting was an effective treatment based on anecdotal evidence. I have nothing against Galen. He was doing the best he could in those days. What I find depressing is that people now want to take us back to those pre-scientific times.

Traditional Chinese medicine is based o Daoism, which believes that all parts of the universe are interconnected. As Chinese medicine forbade dissection, their understanding of human physiology was based on the external world and not on what was going on inside the body. Their 365 divisions of the body were based on the number of days in a year, and the 12 meridians are believed to be based on the 12 major rivers that run through China. The similarity with what was happening in Europe is clear; traditional acupuncture points were very similar to the bloodletting or lancing locations that were being used in Europe. This foundation is problematic for me. We are dealing with philosophies of illness, not scientific theories of disease. They were developed in an era dominated by superstition. I found it hard to take Sharon Stone seriously when she claimed that the 2008 Chinese earthquakes were caused by bad karma. I have a similar opinion of the notion that disease is caused by failure to live in harmony with the Dao. Scientific medicine, which is based on the germ theory of disease and the study of human anatomy and human physiology, is more convincing than TCM explanations. The qi force has never been discovered in physics or human physiology. Maybe supporters will try to claim that qi is metaphorical but I don’t want to be cured with metaphors.

Chinese paediatrician Cheng Dan’an reformed acupuncture in the 1930s, seeking to distance it from bloodletting. Traditional acupuncture points were moved from over veins to over nerves. This modern version of acupuncture is what is taught in the West. Chairman Mao helped give a big boost to acupuncture. It was Mao’s government that coined the term traditional Chinese medicine – TCM. His barefoot doctor campaign of the 1960s was a backlash against Western-style elite medicine. Acupuncturists were a cheap way to provide healthcare to the masses. Acupuncture, which had been banned, was now regarded as equal to Western medicine. Of course Mao himself wasn’t treated with TCM.

It was in the 1970s that TCM began to emigrate west. It meshed perfectly with the hippy/counterculture zeitgeist. Acupuncture, which was part of this trend, was a therapy that could heal everything. President Nixon’s visit to China in 1972 provided an excellent opportunity to promote it. The American delegation saw a patient undergoing major surgery while fully awake, receiving acupuncture instead of anaesthesia. Alas all was not what it seemed to be. The “lucky” patients were chosen for their high pain tolerance and had received intense political indoctrination. And just to make sure, they supplemented the acupuncture with sedatives, narcotics, and local anaesthetics. Historian Paul Unschuld has a damning verdict on acupuncture anaesthesia:

Attempts to use needles instead of drugs to achieve anaesthesia even in major surgical operations have in the meantime slipped into deserved oblivion, just as much as collective management and public self-criticism. It was not until after the ‘Great Proletarian Cultural Revolution’ in 1976 and the opening of China in 1978 that Chinese doctors were able to report, without personal risk, about the pain that patients had been expected to endure through therapy applied in operating theatres not on the basis of scientific knowledge, but in accordance with the ideological precepts of the Communist Party.

What about the clinical research for acupuncture? Although it is notoriously difficult to conduct scientific trials, acupuncture has been one of the most studied fields of alternative medicine. The principal difficulty lies in carrying out double blind trials where neither the practitioner nor the patient know the treatment is real or fake. There are a number of ways of testing: Sham acupuncture involves putting the needles in the wrong places, whereas placebo acupuncture uses a placebo needle. This is a real acupuncture needle with its tip removed. It is designed in such a way that the patient cannot tell if needle has penetrated the skin.

What do the results show? A review of trials of acupuncture for back pain showed that the studies which were properly blinded showed a tiny benefit for acupuncture, which was not statistically significant. The trials which were not blinded showed a massive, statistically significant benefit for acupuncture. How can we explain these results?

I am not convinced that what we see is anything other than the placebo effect. Admittedly, it is a superior version of the effect. While receiving acupuncture, you will be lying down on a table for 30 to 60 minutes. There will be pleasant music playing in the background. As the acupuncturist touches the acupuncture points you will get a pleasant massage. Besides this there is the positive effect of the therapeutic interaction. It would be surprising if it didn’t produce a greater effect than simply taking a sugar pill. Acupuncture does release endorphins. And a 2010 study found that acupuncture needle caused the local release of a chemical known as adenosine, which helped to reduce local pain and inflammation.

However none of this justifies the hype surrounding acupuncture. Considering the inconsistent research results and the improbability of qi and meridians, my verdict has to be negative. Scientific knowledge is like a torch illuminating our dark world. Why ignore this knowledge and replace it with the fairy tales of people who did not have the slightest conception of how the human body worked?

*If you are interested in this area, check out Steven Novella’s NeuroLogicaBlog. The other site I would recommend is Science-Based Medicine. In particular retired doctor Harriet Hall has written some excellent articles debunking Acupuncture.